MEDICARE: MEGAN ALICE WITSOE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972430312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ALICE WITSOE MD

Provider Business Mailing Address
First Line	:	8325 E VIA DE ENCANTO
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3807
Country	:	US
Telephone Number	:	480-399-5654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 N 12TH ST FL 3
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2837
Country	:	US
Telephone Number	:	602-521-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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